,Contents
Breast Examination ……………………………………………………………… 3
Thyroid Examination …………………………………………...…..……..…… 14
Cardio Examination ………………………..………………………………..….. 29
Respiratory Examination …………………………….………...………….……. 46
GIT Examination ……………………………………………………………..… 57
Hernia & Stoma Examination ………………………..………..………..………. 69
Venous Vascular Examination ……………………..………..………...….…… 78
Arterial Vascular Examination …………………………………..………..….… 83
Shoulder Examination …………………………………….……..………..……. 90
Hand Examination ……………………..………..……………………………… 98
Hip Examination …………………………………………..………..….……… 115
Knee Examination ……………………………………………..……………… 124
Spine Examination ……..………..………..………..………..………..……… 132
Upper Limb Neurological Examination ……………………..………...…...… 134
Lower Limb Neurological Examination ………………………..………..…..... 144
Cranial Nerve Examination …………………………..………..……………… 152
Parkinson Examination ……..………..………..………..………..………..…. 168
Acromegaly Examination ……..………..………..………..………..………… 176
Cushing Examination ……..………..………..………..………..………..…… 179
Renal Examination ……..………..………..………..………..………..……… 181
2
, AfraTafreeh.com exclusive
Breast Examination
1. Wash hands, introduce yourself, get name and age, explain your
General roles and gain permission
2. Chaperone or female nurse
3. Top off, setting on side of bed
4. Where is the complaint from Left or right breast?
1. Around the bed
2. patient (metastasis SXS: dyspnea, dysphonia, ascites, weight loss,
cachexia and jaundice)
3. Breast and axilla:
A. Symmetry, Lump, dimpling (cooper ligament), and retraction
B. Skin changes:
Inspection ulceration(cancer)
scar (mastectomy)
erythema: peau d’orange, prominent blood vessel (malignant),
acute mastitis (breast fed, S.aureus) and breast abscess.
C. Skin thickening with prominent pores(cancer)
D. Nipple:
Asymmetry, inverted and retracted (malignant)
Scaling, Rash and ulcer (Paget disease or eczema)
Discharge:
- Blood from single duct: cancer, intraductal papilloma(benign)
- Milk: galactorrhea
- Serous: fibrocystic
- Greenish: ductal ectasias
- Purulent: abscess
4. Ask patient to press hip, raise hands above head, lean forward while
hands above head to elicit dimpling, asymmetry
1. Palpate clockwise with the three middle fingers starting from upper
Palpation: outer quadrant in circular motion including nipple and axillary tail:
1. Lying light and deep palpation If you notice lump:
supine 4S,4Tb, FCM
with the - Site
examined - Size
side hand - Shape
behind - Surface (nodular, smooth, irregular)
head - Border (well, poor defined)
2. Start with - Temperature (back of hands)
healthy - Transillumination
side while - Tenderness (watch pt. face)
3
, Breast Examination
the other - Mobility
covered - Consistency (soft, rubbery, firm, hard)
Fixity (infiltration of tumor):
a) Skin (unable to pinch up the skin away from tumor).
b) Pectoral muscle (try to move the lump with your fingers then ask
press hip if the lump mobility is restricted then it's fixed to muscle)
c) Breast tissue (stabilize the breast with one and move the tumor with
other (fibroadenoma freely movable, caner not
d) Chest wall: immobile at all
2. Squeeze the nipple (send discharge to cytology)
3. Palpate (rolling movement): axillary lymph, Cervical and
supraclavicular lymph nodes (patient arm should be rested in your
arm and warn the patient might be uncomfortable)
*firm non tender slowly progressive (cancer)
Axillary lymph groups:
1. Pectoral(anterior) (main drainage from breast) palpate posterior
surface of pectoralis major muscle while the other hand supporting
the anterior surface of pectoralis major
2. Subscapular (posterior): behind Patient palpate the posterior axillary
fold muscle.
3. Humeral(lateral) with both hands palpate the upper humeral head
4. Central (basal) compress armpit skin above the chest wall
5. Apical behind clavicle: palpate deep in armpit while the other is
supraclavicular fossa
1. Examine for metastasis: lung (pleural effusion, consolidation),
GIT(hepatomegaly), spine(tenderness)
The End 2. Rule out metastasis:
Blood: LFT, hypercalcemia (bony met)
Imaging (chest, abdominal) bone scan
Ultrasound for ovary (krukenberg tumor: transcoelomic spread to
ovary)
Ask patient to cover up and do complete triple assessment (lump)
Lymph drainage:
a. Laterally(major): Axillary lymph nodes Which has three levels in relation to pectoralis
minor:
- One: below
4
Breast Examination ……………………………………………………………… 3
Thyroid Examination …………………………………………...…..……..…… 14
Cardio Examination ………………………..………………………………..….. 29
Respiratory Examination …………………………….………...………….……. 46
GIT Examination ……………………………………………………………..… 57
Hernia & Stoma Examination ………………………..………..………..………. 69
Venous Vascular Examination ……………………..………..………...….…… 78
Arterial Vascular Examination …………………………………..………..….… 83
Shoulder Examination …………………………………….……..………..……. 90
Hand Examination ……………………..………..……………………………… 98
Hip Examination …………………………………………..………..….……… 115
Knee Examination ……………………………………………..……………… 124
Spine Examination ……..………..………..………..………..………..……… 132
Upper Limb Neurological Examination ……………………..………...…...… 134
Lower Limb Neurological Examination ………………………..………..…..... 144
Cranial Nerve Examination …………………………..………..……………… 152
Parkinson Examination ……..………..………..………..………..………..…. 168
Acromegaly Examination ……..………..………..………..………..………… 176
Cushing Examination ……..………..………..………..………..………..…… 179
Renal Examination ……..………..………..………..………..………..……… 181
2
, AfraTafreeh.com exclusive
Breast Examination
1. Wash hands, introduce yourself, get name and age, explain your
General roles and gain permission
2. Chaperone or female nurse
3. Top off, setting on side of bed
4. Where is the complaint from Left or right breast?
1. Around the bed
2. patient (metastasis SXS: dyspnea, dysphonia, ascites, weight loss,
cachexia and jaundice)
3. Breast and axilla:
A. Symmetry, Lump, dimpling (cooper ligament), and retraction
B. Skin changes:
Inspection ulceration(cancer)
scar (mastectomy)
erythema: peau d’orange, prominent blood vessel (malignant),
acute mastitis (breast fed, S.aureus) and breast abscess.
C. Skin thickening with prominent pores(cancer)
D. Nipple:
Asymmetry, inverted and retracted (malignant)
Scaling, Rash and ulcer (Paget disease or eczema)
Discharge:
- Blood from single duct: cancer, intraductal papilloma(benign)
- Milk: galactorrhea
- Serous: fibrocystic
- Greenish: ductal ectasias
- Purulent: abscess
4. Ask patient to press hip, raise hands above head, lean forward while
hands above head to elicit dimpling, asymmetry
1. Palpate clockwise with the three middle fingers starting from upper
Palpation: outer quadrant in circular motion including nipple and axillary tail:
1. Lying light and deep palpation If you notice lump:
supine 4S,4Tb, FCM
with the - Site
examined - Size
side hand - Shape
behind - Surface (nodular, smooth, irregular)
head - Border (well, poor defined)
2. Start with - Temperature (back of hands)
healthy - Transillumination
side while - Tenderness (watch pt. face)
3
, Breast Examination
the other - Mobility
covered - Consistency (soft, rubbery, firm, hard)
Fixity (infiltration of tumor):
a) Skin (unable to pinch up the skin away from tumor).
b) Pectoral muscle (try to move the lump with your fingers then ask
press hip if the lump mobility is restricted then it's fixed to muscle)
c) Breast tissue (stabilize the breast with one and move the tumor with
other (fibroadenoma freely movable, caner not
d) Chest wall: immobile at all
2. Squeeze the nipple (send discharge to cytology)
3. Palpate (rolling movement): axillary lymph, Cervical and
supraclavicular lymph nodes (patient arm should be rested in your
arm and warn the patient might be uncomfortable)
*firm non tender slowly progressive (cancer)
Axillary lymph groups:
1. Pectoral(anterior) (main drainage from breast) palpate posterior
surface of pectoralis major muscle while the other hand supporting
the anterior surface of pectoralis major
2. Subscapular (posterior): behind Patient palpate the posterior axillary
fold muscle.
3. Humeral(lateral) with both hands palpate the upper humeral head
4. Central (basal) compress armpit skin above the chest wall
5. Apical behind clavicle: palpate deep in armpit while the other is
supraclavicular fossa
1. Examine for metastasis: lung (pleural effusion, consolidation),
GIT(hepatomegaly), spine(tenderness)
The End 2. Rule out metastasis:
Blood: LFT, hypercalcemia (bony met)
Imaging (chest, abdominal) bone scan
Ultrasound for ovary (krukenberg tumor: transcoelomic spread to
ovary)
Ask patient to cover up and do complete triple assessment (lump)
Lymph drainage:
a. Laterally(major): Axillary lymph nodes Which has three levels in relation to pectoralis
minor:
- One: below
4
